BONE METASTASIS OF THE STERNUM OR PARASTE RNAL RECURRENCE IN BREAST-CANCER - THE VALUE OF ULTRASOUND

Because of the high tendency of breast cancer to develop metastatic de posits in the skeleton, space-occupying processes in the sternal regio n are mostly attributed to osseous metastases and not to parasternal l ymph node involvement, even in case of solitary lesions, primary tumor localizations in the inner quadrants, positive axillary nodes and neg ative X-ray or bone scan findings. The sonographic examinations of 115 patients with breast cancer and clinical and/or scintigraphic suspici on of sternal metastasis, however, revealed the typical bone metastase s of the sternum with a small soft tissue tumors in only 27.8%, wherea s 59.1% of the cases showed parasternal recurrences; 5.2% had both. No n-tumorous changes were seen in 6.1%, equivocal results in 1.7%. Solit ary osseous metastasis of the sternum was rare; multiple skeletal lesi ons were found in the majority of this group in contrast to the patien ts in the parasternal relapse group, which moreover showed strong over representation of the primary tumor localization in the inner quadrant s. X-rays of the chest or the sternum were often false-negative and no t reliable, the bone scans positive only in cases of secondary sternal invasion or skeletal metastases, Concerning reliability and cost, son ography was the imaging method of first choice for diagnosis, therapy planning and follow-up for space-occupying processes in the sternal re gion, with CT or MRI as adjuncts in cases of extended tumors invading the mediastinum.